Experiences of older people, healthcare providers and caregivers on implementing person-centered care for community-dwelling older people: a systematic review and qualitative meta-synthesis

Abstract

Background Person-centered care (PCC) is a critical approach to improving the quality of care for community-dwelling older people. Old-age care services could be provided according to older peoples’ choices, needs, and preferences. The purpose of this study was to synthesize research evidence on the experiences of older people, healthcare providers, and caregivers with PCC and to identify the enablers and barriers to implementing PCC for community-dwelling older people. Methods A meta-synthesis of qualitative research design was adopted. Data searches were performed using CINAHL (EBSCOhost), PubMed (OvidSP), Embase (Ovid), Cochrane Database, and PsycINFO (Ovid) in published articles and were reviewed from the earliest date to February 2023. The Qualitative Method Appraisal Tool was used to conduct a quality appraisal on selected articles. Data were extracted based on the capacity, opportunity, and motivation-behavior model (COM-B model), and the findings were synthesized using the meta-aggregative approach. Results Twelve included articles were analyzed to identify 122 findings that were organized into 11 categories and combined into three synthesized findings—capacities of older people, healthcare providers, and caregivers; opportunities in the implementation of PCC; motivation in implementing PCC. Capacities consisted of a lack of person-centered knowledge and skills, negative attitudes toward shared decision-making, and a lack of formal training to enhance capabilities among HCPs. Opportunities included a lack of coordination in resource allocation, strengthening multidisciplinary teamwork, establishing a desirable environment, and time constraints. Motivation in implementing PCC included encouraging self-reflection and regulation, respecting the autonomy of older people, lack of clear reward and empowerment mechanisms, and being resilient and optimistic. Conclusions The findings of this research provide a reference for implementing successful PCC in the community. The researchers identified barriers and facilitators of implementing PCC, facilitating through stakeholder’s person-centered knowledge and skills being valued and respecting the autonomy of older people. Establishing a positive environment and strengthening multidisciplinary team members also promotes the implementation of PCC. However, additional studies are required to explore the influencing factors and address the barriers.

Thanks for hearing me: key elements of primary care according to older patients

“…There are possible barriers to successful implementation in primary care, such as organisational cultures, physicians’ workloads, inadequate indicators for healthcare measurements and financing, as well as ethical concerns when a person makes a decision that the healthcare provider strongly disagrees with, and that puts the person at significant risk [ 37 ]. There are also facilitating factors, through stakeholders’ person-centred knowledge, respecting the autonomy of older people, and strengthening multidisciplinary team members, for implementation among community-dwelling old people [ 41 ]. Staff training to increase knowledge and support working in teams with this patient group should be prioritised.…”

Radiographers’ perspectives on interactional processes during older persons diagnostic medical imaging encounters: a qualitative study

“…Data collection occurred between July 2022 and February 2023 and involved individual, open-ended interviews conducted online or by telephone with radiographers practicing in private and public medical imaging settings in Australia. An interview guide was developed from literature [ 7 , 10 – 12 ] and clinical experience. It consisted of open-ended questions with probes on participants’ experiences of elderly patient diagnostic medical imaging encounters, delivery of person-centred care, appropriate communication styles and suggestions for the emerging cohort of radiographers (see attached supplementary file 1 ).…”

“…As part of the multidisciplinary team, radiographers are expected to deliver individualised quality person-centred medical imaging services. For the elderly person referred for a medical imaging examination, it is expected that services will be tailored to align with their choices, needs and preferences [ 7 ]. Given the brief and focused nature of general radiographic examinations, radiographers are required to effectively convey information, provide opportunities for information exchange and instruct the patient using both verbal and non-verbal cues, along with physical manipulation of the body part region of interest and equipment [ 6 ].…”

“…In the provision of medical imaging services, the approach to caring for frail and vulnerable elderly patients may differ from other age groups [ 7 ]. The diagnostic imaging of elderly patients requires specialised knowledge, as it can sometimes be difficult to distinguish between the natural ageing process and disease [ 10 ].…”

Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users

“…In the health care context, Liao et al [22] mentioned that establishing a clear reward mechanism could foster active engagement and empowerment. Thus, we predict that experientially rewarding content can help in seeding more motivation and empowerment.…”